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Clinical Center News

Published monthly for CC employees by
Office of Communications, Patient Recruitment, and Public Liaison.

Goodall met the packed Clinical Center Masur Auditorium with a vocalization of a typical chimpanzee greeting call that one might hear in Gombe National Park in Tanzania, Africa, where she began her groundbreaking research more than 50 years ago.

As a child, Goodall dreamed of living among the animals and writing about them. She began honing her research and observational skills at the age of four when she spent hours waiting to see how her family’s hens laid eggs. Goodall traveled to Africa in her early twenties to pursue her dreams and was hired as an assistant by the famed anthropologist and paleontologist Louis Leaky. Impressed with Goodall’s talent and energy, he asked her to undertake a study of wild chimpanzees living in what is now Tanzania.

Without a degree or scientific training and armed only with a notebook, pencil, and binoculars, Goodall pioneered research on chimpanzees and observations of the behavior of one of our closest relatives. She recorded chimpanzees using tools; communicating; and engaging in human-like behaviors such as hugging, kissing, and patting on the back. Goodall revolutionized thinking regarding chimpanzees and primates and their behavioral and biological connection to human beings.

“Her observations in those years transformed our understanding of chimpanzees,” said NIH Director Dr. Francis S. Collins in his introduction. “She taught us many things about our closest relatives that are relevant today, as we contemplate who we are, and also our role as stewards of the planet to take care of other species.”

Goodall described some of the research projects conducted at Gombe over the last half century, including investigations of aging, transfer of disease, and chimpanzee culture.

“The chimpanzees, for Leaky, were a doorway into understanding something about a possible pathway of human evolution,” said Goodall. Later as part of the Human Genome Project, the doorway was opened further when the chimpanzee genome was found to share 95 to 98 percent of the same DNA as humans.

“So here we are, with these amazing chimpanzee beings, more than us like any other,” Goodall said. “And how tragic that they are vanishing in the wild from between one and two million, in 1900, to roughly 300,000 to 170,000 spread across 21 countries today.”

According to Goodall, human population growth, habitat destruction, and the illegal commercial bushmeat trade have all contributed to this drastic decline.

Goodall also delicately addressed the issue of animal experimentation. “A lot of people shy away from talking about these issues, but we have to talk about them. They are there,” she said. “With these amazing brains, let’s get together and find new ways of doing things as quickly as we can so we don’t need animals in medical research. We need to dream big for the future, to get the kind of world that we might be happy to live in.”

Earllaine Croarkin, a CC Rehabilitation Medicine Department therapist, arrived an hour before the lecture to make sure that she and her 4-year-old son would get to see Goodall speak. “I am interested in getting to hear about what a world-class icon has to say about the environment and where it will be in 50 years,” she said. Croarkin reported that she and her son would be joining Jane Goodall’s Roots & Shoots, the Jane Goodall Institute’s global environmental and humanitarian youth program, as soon as they got home.

As an advocate, Goodall travels more than 300 days a year encouraging individuals to help make the world a better place for people, animals and the environment we all share. She closed her lecture by encouraging each member of the audience to think about the consequences of the choices he or she makes. “Every single day, every single one of us makes a difference,” Goodall said.

Updated guidelines aim to eliminate infections

Clinical scientists in the Clinical Center Critical Care Medicine Department (CCMD) have led a revision of the 2002 “Guidelines for Prevention of Intravascular Catheter-Related Infections,” which have been widely influential in contributing to efforts to reduce the impact of catheter infection on patient outcome in hospitals in the United States and around the world.

The new guidelines, which are endorsed by the Centers for Disease Control and Prevention (CDC) and multiple professional societies, were published April 1 in Clinical Infectious Diseases.

“Hospital-acquired infections, and particularly catheter-related bloodstream infections (CRBSI), are now an important benchmark of hospital quality and patient safety,” said lead author Dr. Naomi O’Grady, medical director of procedures, vascular access, and conscious sedation services in the CCMD.

The average CRBSI incidence is about 2.3 per 1,000 patient-catheter days. In US intensive care units (ICUs), about 80,000 CRBSI occur each year and with them, morbidity, mortality, and extended hospital stays.

Catheter-related infections are now seen as largely preventable. In an effort to encourage stringent prevention efforts, Medicare will no longer reimburse for CRBSI acquired during hospitalization, which has hospitals eager to eliminate such infections, O’Grady said.

These guidelines are updates of a process that began in 2000 when O’ Grady and CCMD Chief Dr. Henry Masur were approached by the Society of Critical Care Medicine to develop guidelines to reduce the incidence of CRBSI in ICUs. Recognizing that catheter infections involve health-care professionals from many disciplines, Masur and O’Grady expanded the scope of the guidelines creation process to include the CDC and 11 other professional organizations so that physicians and nurses across disciplines would have one set of guidelines to follow.

The CCMD continued to unite physicians and other health-care providers from various specialties—encouraging several more professional organizations to participate—to produce the current guidance to improve patient outcome.

Previous prevention efforts have focused on central venous catheter placement in ICUs due to the procedure’s frequency and the profound effect of hospital-acquired infections on ICU patients. Improved technology has now allowed hospitals to better track CRBSI on other units and in outpatient settings, focusing on patients undergoing cancer treatment or receiving parenteral nutrition.

Many infections occur in patients with longer catheter dwell time (more than seven days), so maintenance and not just insertion is a concern. The guidelines’ authors appeal to a variety of audiences to help prevent CRBSI: those who order the catheter placement, those who insert and maintain intravascular catheters, infection control officers, and patients who are able to assist in the care of their catheters.

Major areas of emphasis in the guidelines include educating and training health-care personnel, using maximal sterile barrier precautions during catheter insertion, skin preparation with chlorhexidine for antisepsis, and avoiding routine replacement of central venous catheters.

Another suggestion is implementation of bundled strategies, where all the supplies for a central venous catheter insertion are packed in a kit at the ready. However, the greatest return on investment might be commitment to process.

“You can get to very low rates of infection without using novel techniques,” O’Grady said. “It’s attention to detail and diligence in adhering to the standards of catheter care that really pay off.”

Hollywood hits NIH: Alan Alda and Geena Davis visit the CC

Actress Geena Davis toured the 7SW Metabolic Clinical Research Unit with CC Director Dr. John I. Gallin on April 25 a presentation on the work of her institute for gender equality in media.

Six-time Emmy Award and Golden Globe Award winner Alan Alda (left) visited the CC in March. Best known for his role as Hawkeye Pierce in the TV series M*A*S*H, Alda visited the 1NW pediatric unit on a tour with CC Director Dr. John I. Gallin.

Geena Davis engages NIH on gender balance in media

The NIH Office of Research on Women’s Health hosted Academy-Award winning actress Geena Davis at the Clinical Center on April 25. Davis presented research findings from the nonprofit Geena Davis Institute on Gender in the Media and took a tour of the CC.

Davis’ institute analyzed television and movies aimed at children for presence and depiction of female characters. Their research shows little change in inclusion of females over the last 20 years and hypersexualization of female roles that are included. The institute has approached writers, directors, and studio heads with its data, and the response has been shock and a pledge to move toward gender balance and stronger, less sexualized role models, Davis said.

“What message are we sending to our kids when female characters are so one-dimensional, sidelined, hypersexualized or not there at all?” Davis asked. She also mentioned that the number one career for female animated characters is royalty, with no women shown in scientific or mathematical careers.

Those present at the meeting with Davis—who won the 1988 Academy Award for Best Supporting Actress for The Accidental Tourist and is also known for her roles in A League of Their Own and Thelma and Louise—included institute directors and NIH leaders. Conversation revolved around the psychological effects of females’ marginalization in children’s programming and strategies to train the next generation of writers-directors.

Alan Alda advocates effective scientific communication

He’s not a doctor, but he played one on TV. Actor and science communications advocate Alan Alda toured the Clinical Center on March 1.

Alda visited as a speaker for the Staff Training in Extramural Programs (STEP) forum titled, “Look Who’s Talking: Communicating Your Message Fearlessly and Flawlessly.” His presentation emphasized the importance of training scientists and health professionals to communicate more effectively.

American College of Physicians honors critical care medicine chief

Dr. Henry Masur, chief of the Critical Care Medicine Department, was honored with the John Phillips Memorial Award from the American College of Physicians in April.

Dr. Henry Masur, chief of the Clinical Center Critical Care Medicine Department, was honored with the John Phillips Memorial Award for Outstanding Work in Clinical Medicine from the American College of Physicians at its annual convocation ceremony on April 7 in San Diego.

“This award highlights the opportunities that NIH provides intramural scientists to make contributions to clinical medicine and science. The resources and collaborators in the intramural program and the stability of funding provide opportunities to embark on ambitious projects that would be more difficult to accomplish at other institutions,” Masur said.

Since recognizing the first cases of AIDS in New York City in 1981, Masur has become one of the world’s leading authorities on HIV and related opportunistic infections. He formulated the first national guidelines for treating HIV/AIDS that laid the path for future NIH guidelines for HIV management.

Masur earned his undergraduate degree from Dartmouth College and his medical degree from Cornell University Medical College. He completed his internship and residency in internal medicine at New York Hospital and Johns Hopkins Hospital. Following a fellowship at Cornell in the Division of Infectious Diseases and Internal Medicine, he served as an instructor and assistant professor of medicine in the Infectious Diseases Division at Cornell from 1978 to 1982.

Masur was recruited to NIH to jointly found a new department of critical care medicine and an HIV/AIDS program with the National Institute of Allergy and Infectious Diseases. He became chief of the CC Critical Care Medicine Department in 1989. During the past 20 years the department has attained national and international acclaim for its leadership in areas of sepsis, emerging infections, HIV/AIDS, lung biology, and sickle cell disease.

Masur is clinical professor of medicine at George Washington University and holds appointments at the University of Maryland and the Washington Hospital Center. He is the recipient of two NIH Director’s Awards and a Hero of Medicine Award from the International Association of Physicians in AIDS Care.

The John Phillips Memorial Award for Outstanding Work in Clinical Medicine was established in 1929 in honor of Dr. John Phillips, former governor and regent of the American College of Physicians.

Take a bite into a healthy spring recipe from the Clinical Center’s executive chef

Spring is here—and fresh produce is one delicious benefit of this season of growth. Clinical Center Executive Chef Robert Hedetniemi prepares weekly specials for patients that often include fresh, seasonal ingredients like this portobello mushroom sandwich. For more information about the CC Nutrition Department, visit www.clinicalcenter.nih.gov/nutr/index.html.

Portobello Mushroom SandwichServes 4

Ingredients:

4 small ciabatta Rolls

1 yellow pepper

4 ounces fresh mozzarella, sliced

12 fresh basil leaves

2 medium tomatoes, sliced

8 portobello mushroom caps

1/2 teaspoon pepper

Marinade:

1/8 teaspoon black pepper

2 tablespoons low-sodium Worcestershire sauce

2 and 2/3 tablespoons olive oil

2 and 2/3 tablespoons vinegar

1 teaspoon ground thyme

1 teaspoon whole leaf Rosemary

Method of preparation:

Mix together above marinade ingredients. Remove mushroom stems and “gills.” Place mushrooms in a shallow pan, covering with marinade. Place in the refrigerator and let marinate for several hours.

Medical Venturing Program students explore CC resources

George Altizer (right), a clinical research nurse in Radiology and Imaging Sciences, says he enjoys doing educational activities with a new generation. He showed the group of high school students from the Suburban Hospital Medical Venturing program several catheters used during image-guided procedures.

A group of high school students with an interest in health and medicine visited the Clinical Center in April as part of the Suburban Hospital Medical Venturing program. The visitors received a general tour of the CC and a detailed look at Radiology and Imaging Sciences.

The Medical Venturing Program offers a unique opportunity for high school students interested in the medical field to learn from experts about a variety of potential careers. Program coordinator Roliette Gooding organized the CC visit to give program participants a different perspective regarding hospitals. “Our overall goal was to educate them about the difference between a community hospital and a research hospital, which may help them in the future when they are looking for opportunities available to them in the health-care industry,” Gooding said.

CC tour guides explained some of the differences between the resources available at the CC and took questions from students. Several staff members commented that they wished they had a chance to participate in such a program. Dr. Les Folio, lead radiologist for computed tomography (CT), explained how he didn’t discover his passion for science and medicine until after high school. “When I was in high school, I studied photography,” he said. “My interest in photography lead to X-ray technologist training, then I became CT tech, and then medical school.”

Medical Venturing Program students have observed and participated in activities—observation of open heart surgery, suturing practice, and interactive pathology laboratory workshops—at Suburban Hospital and other area health-care facilities.

Publications address recruitment and participation in clinical trials

Improving Recruitment of Racial/Ethnic Minorities into Clinical TrialsHIV infection rates are disproportionately high among racial and ethnic minorities in the United States. This makes it all the more important for clinical trials to include these individuals in clinical trials.

The Journal of the Association of Nurses in AIDS Care will include an article—“Conducting HIV Research in Racial and Ethnic Minority Communities: Building a Successful Interdisciplinary Research Team”—by Clinical Center staff that addressed this problem. The article is currently published online, and will be available in print in the the November/December issue. Frinny Polanco, Dinora Dominguez, Dr. Christine Grady, Pamela Stoll, Catalina Ramos, Joann Mican, Robert Miranda-Acevedo, Marcela Morgan, Jeasmine Aizvera, Lori Purdie, Deloris Koziol, Migdalia Rivera-Goba examined how a skilled interdisciplinary team that includes researchers with racial and ethnic diversity can help include minority individuals in clinical trials.

Interdisciplinary teamwork mattersSuccessful teamwork depends on empowered members who function cohesively for the benefit of their members.

Key elements of a successful approachSensitivity and participation are crucial for assuring success in assisting racial and ethnic minorities achieve better health. Build relationships with research participants to increase the probability that racial and ethnic minorities will enroll and fully take part in research.

Implication for practiceHealth-care practitioners can learn from this model by applying the principles of involvement, engagement, and respect to improve the health and well being of those in their care.

Addressing Factors Affecting Participation in Clinical TrialsRecruiting participants representative of a target population plays a pivotal role in the design of effective clinical trials.

Clinical Center staffers Migdalia Rivera-Goba, Dinora Dominguez, Pamela Stoll, Dr. Christine Grady, Catalina Ramos, and JoAnn Mican collaborated on a study examining this challenge. The results currently appear online and will appear in the July/August issue of the Journal of the Association of Nurses in AIDS Care.

Key factors influencing participationFour salient factors emerged that affect the participation of Hispanic and African-Americans in clinical research: beliefs about research benefits and risks, enhancers to participation, psychosocial factors, and barriers to participation.

Implications for clinical practiceTo address the challenge of designing clinical research studies whose results will be relevant to various racial/ethnic minorities, health-care practitioners should consider these four factors.

CRTP fellows ready to wrap up a successful year of translational research

Oren Goltzer from the University of Miami has enjoyed learning the clinical research process during his CRTP fellowship in the Rehabilitation Medicine Department.

The 2010-2011 NIH Clinical Research Training Program (CRTP) fellows will deliver their year-end scientific presentations on May 16 and 17 in the Building 60 (Cloisters) lecture hall. These presentations are the highlight of the CRTP academic year, and each fellow delivers a formal lecture on his/her clinical or translational research to the NIH community and other special guests. The presentation topics and schedule can be viewed at www.cc.nih.gov/training/news_events.html.

Tara Spivey of Rush Medical College in Chicago returned to the laboratory of Dr. Francisco Marincola of the Clinical Center Department of Transfusion Medicine after participating in the NIH Summer Internship Program there two years ago. Her research is on “Genetic Analysis of Melanoma Cell Lines Derived from Well Characterized Metastatic Melanoma Tissues.”

“Working with Dr. Marincola is wonderful. He truly cares about making me a better researcher,” Spivey said. “I think I can speak for everyone in the program, it has been as much as we expected and then some—really stimulating and exciting.”

CRTP fellows also will participate in the NIH Spring Research Festival poster session on May 19 from 11:00 am to 1:00 pm in parking lot 10H adjacent to the south entrance of the CC.

The CRTP is a public-private partnership supported jointly by the NIH and the Foundation for NIH through a grant from Pfizer Inc. At a time when translational science is a priority on the national research agenda, the CRTP emphasizes a well-rounded research experience for the next generation of clinician-scientists.

This year’s class of 30 CRTP fellows represents 22 US medical schools. Each fellow committed to an additional year of medical school in order to participate in this 12-month enrichment program. Since 1997, the CRTP has provided 310 highly qualified, research-oriented medical and dental students the opportunity to engage in a mentored clinical or translational research project in an area that matches their career and research goals and interests.

Oren Goltzer from the University of Miami Leonard M. Miller School of Medicine has been working with Dr. Francis Sheehan Gavelli of the CC Rehabilitation Medicine Department on “The Role of Patellofemoral Kinematic and Kinetic Parameters in Patellofemoral Pain Syndrome.” He credits his time in the CRTP with laying the foundation for a future in clinical research.

“This has been an incredible opportunity and has taught me a lot about research in both my area of study (musculoskeletal) and in general,” Goltzer said.

For more information about the CRTP and all of the CC’s training opportunities, visit the Office of Clinical Research Training and Medical Education website at www.cc.nih.gov/training.

Medicine for the Public will highlight depression and obesity research

Discover the latest in research for two of today’s most common health problems at the 2011 Medicine for the Public Lecture series.

The first lecture, “Confronting Obesity: Updates in Prevention and Treatment Research,” will be held on May 17. Obesity is a major contributor to serious health conditions in children and adults, including type 2 diabetes, cardiovascular disease, many forms of cancer, and numerous other diseases and conditions. Obese individuals also may experience stigma and discrimination.

In the May 17 lecture, experts will explore the influences of metabolic rate on body weight, review trends in obesity and its consequences, look at risk factors and clinical complications for both adult and childhood obesity, and provide evidence-based approaches to treatment and prevention of obesity. This lecture will be presented by Dr. Kong Y. Chen (NIDDK), Dr. Lawrence Appel (Johns Hopkins Medicine), and Dr. Tania Heller (Suburban).

The second lecture “Challenging Depression: New Insights into Research and Treatment,” will be held on May 24. Depression is a common but serious illness that interferes with daily life, normal functioning and causes pain for the patient and those who care about them. Although a disabling disorder, depression can be treated effectively.

In the May 24 lecture, experts will look at two forms of depression and a treatment option for more severe conditions. Topics include bipolar disorders, depression during pregnancy, and electroconvulsive therapy. This lecture will be presented by Dr. Carlos A. Zarate, Jr (NIMH); Dr. Jennifer Lanier Payne (Johns Hopkins Medicine); and Dr. David T. George (Suburban).

Both lectures will be held from 7:00 to 8:30 pm at the Suburban Hospital Auditorium. Register by calling 301-896-3939.

Lectures are free and open to the public. Light refreshments will be served at 6:30 pm.

The Medicine for the Public lecture series has been a cornerstone public health education program hosted by the Clinical Center since 1977. Today, the lecture series is presented as a new collaborative program between the CC, Suburban Hospital, and Johns Hopkins Medicine. This collaboration couples the strengths of three institutions and expands the scope of expertise available to include experts working in areas ranging from basic research laboratories to hospitals and community programs.

Clinical Pastoral Education program celebrates milestones

The Spiritual Ministry Department’s Clinical Pastoral Education program celebrated a 10-year accreditation this year as well as the graduation of six program participants in April including (back row from left) Chaplain Interns David Rose, Rick Hudock, Peter Hanke, Bruce Lugn, and (front row, from left) Chaplain Intern Barbara Bordelon, Rev. Ellen Swinford, and Chaplain Intern Cynthia Hill Dopp.

The Clinical Center Spiritual Ministry Department has much to celebrate after successfully completing its 10-year accreditation review from the Association for Clinical Pastoral Education.

“We were indeed very pleased to receive notice of our continued accreditation,” said Chaplain John Pollack, chief of Spiritual Ministry. “That the continued accreditation was granted without any notations validates all of the hard work and effort that have gone into revitalizing this program.”

The accreditation allows the Spiritual Ministry Department to host Clinical Pastoral Education (CPE) interns, six of whom graduated from the program this April. The multi-faith group participated in a 25-week program designed to provide participants with the opportunity to hone pastoral skills while working under supervision with patients and families facing medical challenges.

Rev. Ellen Swinford, CC chaplain and Clinical Pastoral Education program Supervisor who coordinates the program, explained the benefits of working in the CC’s unique patient-care environment, “People who participate in research have been dealing with serious medical challenges that often impact their lives for years,” she said. “Many of our patients have exhausted other resources, which can raise significant spiritual questions and faith concerns. Providing spiritual care in the face of these questions is a very powerful experience, and a good way for spiritual leaders to develop competencies that they can take with them into other contexts of spiritual or pastoral ministry.”

According to Swinford, program participants grow to understand the impact of suffering on people’s spiritual lives, while building the skills necessary to work collaboratively with health-care providers to ensure that the needs of patients are addressed with respect and sensitivity.

The CC is one of more than 300 centers accredited by the Association for Clinical Pastoral Education.

News Briefs

Subsidy for employees who bike to workThe Department of Health and Human Services announced this April that federal employees who bike to work are eligible to receive a $20 monthly subsidy.

Biking to work can improve health and wellness, help reduce traffic congestion, and contribute to cleaner air quality. HHS federal employees who bike to work are eligible to receive a $20 monthly subsidy through the program support center Bicycle Subsidy Program. To receive an information package and application, email GoCard@HHS.gov or visit www.hhs.gov/travel/Bike2Work.

Shuttle routes changeThe perimeter and campus limited shuttle routes have been combined to make one new route.

The new route serves the NIH Perimeter from 6:30 am until 9:00 am and again from 4:30 pm until 7:30 pm. From 9:00 am until 4:20 pm, the route will cover the Campus Limited route servicing the NIH Campus.

For questions regarding this message, please contact the ORS Information Line at orsinfo@mail.nih.gov or 301-594-6677. Please tune your radios to 1660 AM for NIH traffic, parking, and perimeter security advisories.

Race for a cure with Team NIHJoin Team NIH at the Susan G. Komen Global Race for the Cure 5K (3.1 miles) on June 4 on the National Mall in Washington, DC. Walk or run to support breast cancer research; no fundraising is required. Choose “Join a Team” and search for Team NIH at http://globalrace.info-komen.org.

Team captains will send an email with meet-up instructions to participants closer to the event. Contact Maggie McGuire at mcguirema@mail.nih.gov for more information.

Improving lives through discoveryThe National Institute of Arthritis and Musculoskeletal and Skin Diseases will celebrate its 25th anniversary with a scientific symposium titled “Improving Lives Through Discovery” on June 13. The symposium will be from 8:30 am - 4:30 pm in Lipsett Auditorium. For more information, visit www.niams.nih.gov.